November 13, 2002

Educating for compliance or choice?

In his response to my Diary entry about Unmotivated Educators, John Lee asks if we should be teaching parents about options that are unavailable. This is an interesting question and one that often comes up in Teaching Skills workshops.

The issue boils down to: do we teach for compliance or do we teach for informed choice? Many educators take the position that if a service is not available in their unit (e.g. water birth) or Trust area ( e.g. homebirth) that there is little point in alerting parents to these options because they won’t be able to get them. Others believe that if the options exist, then parents should know of them, even if it will be difficult or impossible to get them in their area.

The changes that have come about in maternity care over the years have been consumer driven - think of fathers in the labour ward, rooming in, water birth and birth centres. None of these would have been introduced by the obstetricians or hospital administrations (although they have been able to introduce widespread use of CTGs and epidurals!) and it has been dogged perseverance by parents that has forced these services to be provided. They heard about these options from various sources - their own reading, from other parents and from childbirth educators.

If parents know of a service that is not available where they live, but could be obtained elsewhere (perhaps even in the next Trust area) then they have a right to request the same level of care. If the health service is not asked to provide a service they may conclude that nobody wants it. Therefore, as drivers of change, parents and educators play vital roles in improving services and pushing reforms through.

I believe that educators have a duty of care to explain all possible options to parents. It is up to the parents to find out what is available and to take the necessary steps to get what they want (even if this involves some inconvenience). Teaching for compliance may make life easier for the hospital staff, but goes completely against the basic principles of informed choice. But that is a myth anyway, isn’t it?

Posted by andrea at November 13, 2002 10:49 AM

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